TY - JOUR T1 - Efficacy of high-flow oxygen and active humidification in a patient with acute respiratory failure of neuromuscular origin. JF - Respiratory Care DO - 10.4187/respcare.02115 SP - respcare.02115 AU - S Díaz- Lobato AU - MA Folgado AU - A Chapa AU - S Mayoralas Y1 - 2013/04/30 UR - http://rc.rcjournal.com/content/early/2013/04/30/respcare.02115.abstract N2 - The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in situations of hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years high-flow oxygen therapy and active humidification devices have been introduced in the medical practice. They are emerging evidence that high-flow may be effective in different clinical settings: such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in Do-Not-Intubate patients, in the case of patients with chronic cough and copious secretions, pulmonary fibrosis or cancer, both in critical areas or in the emergency department. We have studied a patient suffering from amyotrophic lateral sclerosis (ALS) who arrived at the emergency department with acute hypercapnic respiratory failure, which was treated successfully with a heated, humidified high-flow oxygen therapy device (HFNC). The patient did not tolerate NIV and we decided to try the HFNC as an alternative to intubation, since the patient had also rejected the application of invasive measures. An ABG performed after an hour of treatment showed a trend for improvement of both the pH, and the PCO2, and also improved the level of awareness of the patient. Respiratory acidosis was corrected and the patient could be discharged after 5 days of hospitalization. The response to HFNC was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy and the need for research on this in the future. ER -